scholarly journals Free Neurocognitive Screening Initiative: An Opportunity to Address Health Disparities and Promote Cultural Competence in Northcentral Florida

2019 ◽  
Vol 34 (7) ◽  
pp. 1294-1294
Author(s):  
P Amofa Sr. ◽  
F Arias ◽  
E Trifilio ◽  
J Belser-Ehrlich ◽  
B Rohl ◽  
...  
Keyword(s):  
Cultural Competence ◽  
Doctoral Students ◽  
Rural Areas ◽  
Phase 1 ◽  
Clinical Work ◽  
Cognitive Testing ◽  
Community Resources ◽  
Phase 2 ◽  
Clinical Neuropsychology ◽  
Alachua County

Abstract Objective The risk for cognitive impairment is greater in individuals with low SES and limited education. In rural areas, distance and economic concerns preclude individuals from accessing care. In Alachua County, 23% of residents live below poverty and 16% are uninsured. The Neurocognitive Screening Initiative (NSI) attempts to reduce disparities in Alachua by offering free neurocognitive screening. NSI also aspires to promote cultural competence through unique training opportunities for clinical neuropsychology doctoral students. Method Patients learned about NSI through flyers, word of mouth, or referrals. Appointments include a clinical interview, cognitive testing, and mood questionnaires. Patients receive feedback, brain health recommendations, and referrals to community resources. Phase 1 began in November 2017 and involved selection of appropriate cognitive measures, development and dissemination of advertising materials, identification of resources, and trainee recruitment. From February 2018 to August 2018, phase 2 involved administration of cognitive screeners. Phase 3 involved continued provision of clinical services, expansion of the NSI team and increased culturally relevant outreach. Outcomes NSI’s greatest challenge is recruitment of the appropriate demographic. Since phase 2, we have evaluated 10 patients with diverse racial, socioeconomic, and clinical characteristics. NSI has recruited an ethnoracially diverse cohort of trainees comprised of 4 graduate students and 2 postdoctoral fellows supervised by a clinical neuropsychologist. Discussion Efforts to provide services to marginalized individuals have uncovered challenges in attracting patients who might benefit from these services. NSI is forging community partnerships with churches, libraries, and local organizations to reach the targeted audience. Via weekly meetings, participation in community events/outreach, and clinical work, NSI provides unique training for emerging neuropsychologists.

scholarly journals Older Adults’ Utilization of Community Resources Targeting Fall Prevention and Physical Activity

2018 ◽  
Vol 59 (3) ◽  
pp. 436-446 ◽  
Author(s):  
Siobhan K McMahon ◽  
Young Shin Park ◽  
Beth Lewis ◽  
Weihua Guan ◽  
J Michael Oakes ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Fall Prevention ◽  
Local Community ◽  
Phase 1 ◽  
Implementation Strategies ◽  
Community Resources ◽  
Phase 2 ◽  
Internal Resources ◽  
Diagnosis Of Dementia

Abstract Background and Objectives Despite the availability of community resources, fall and inactivity rates remain high among older adults. Thus, in this article, we describe older adults’ self-reported awareness and use of community resources targeting fall prevention and physical activity. Research Design and Methods In-depth, semistructured interviews were conducted in Phase 1 with community center leaders (n = 5) and adults (n = 16) ≥70 years old whose experience with community programs varied. In Phase 2, surveys were administered to intervention study participants (n = 102) who were ≥70 years old, did not have a diagnosis of dementia, and reported low levels of physical activity. Results Four themes emerged from Phase 1 data: (a) identifying a broad range of local community resources; (b) learning from trusted sources; (c) the dynamic gap between awareness and use of community resources; and (d) using internal resources to avoid falls. Phase 2 data confirmed these themes; enabled the categorization of similar participant-identified resources (10); and showed that participants who received encouragement to increase community resource use, compared to those who did not, had significantly greater odds of using ≥1 resource immediately postintervention, but not 6 months’ postintervention. Discussion and Implications Although participants in this study were aware of a broad range of local community resources for physical activity, they used resources that support walking most frequently. Additionally, receiving encouragement to use community resources had short-term effects only. Findings improve our understanding of resources that need bolstering or better dissemination and suggest researchers identify best promotion, dissemination, implementation strategies.

scholarly journals Development and feasibility of a modified Fugl-Meyer lower extremity assessment for telerehabilitation: a pilot study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Sue Peters ◽  
Marcela Botero ◽  
Allison Evers ◽  
Brianna Fong ◽  
Botond Jakab ◽  
...  
Keyword(s):  
Pilot Study ◽  
Lower Extremity ◽  
Rural Areas ◽  
Phase 1 ◽  
Motor Impairment ◽  
Community Dwelling ◽  
Stroke Survivors ◽  
Phase 2 ◽  
Phase 3 ◽  
Face To Face

Abstract Background The majority of stroke survivors experience motor impairment which benefits from rehabilitation treatment. Telerehabilitation, remote delivery of rehabilitation services, is a possible solution providing access to rehabilitation for stroke survivors living in rural areas or in situations like the COVID-19 pandemic where face-to-face treatment may be risky. However, valid and reliable motor impairment measures have not yet been established over a telerehabilitation platform. The Fugl-Meyer (FM) lower extremity assessment is widely used clinically and in research. Thus, the aim was to develop a modified FM for telerehabilitation (FM-tele) and assess the feasibility and preliminary agreement of FM-tele scores with the FM. Methods Three phases were employed: phase 1 development, phase 2 feasibility, and phase 3 preliminary agreement. Literature review and consultation with clinicians were employed to develop the FM-tele. Community-dwelling individuals with stroke and FM evaluators were consulted to provide feedback via questionnaires on the feasibility of the FM-tele. To assess the preliminary agreement of the FM-tele, individuals with stroke participated in two sessions, one in-person and one via telerehabilitation. The standard version of the FM was administered during the in-person session. The FM-tele was administered in both sessions. Results From phase 1, clinician consultation identified the following key principles: safety of the client, clear lower extremity visualization, and minimization of position changes which guided FM-tele development (n = 7). Feasibility was established in phase 2 where participants with stroke indicated that they felt safe and experienced ease following the standardized instructions, despite some technological concerns (n = 5). FM evaluators agreed that participants were safe and indicated effective standardized instructions. Phase 3 (n = 5) indicated preliminary agreement of the FM-tele compared with the FM. Conclusions Participants with stroke and clinical consultation indicated the FM-tele developed for telerehabilitation is feasible. A lower extremity motor assessment tool for telerehabilitation is urgently needed for stroke survivors living in rural areas or when face-to-face visits are impossible. This pilot study provides preliminary support for a future study.

scholarly journals A Strategic Action Plan to Enhance the Accessibility of Healthcare in Rural Areas of Zimbabwe

2020 ◽  
Author(s):  
Manenji Mangundu ◽  
Lizeths Roets ◽  
Janse Van Rensburg
Keyword(s):  
Public Health ◽  
Health Care ◽  
National Health ◽  
Rural Areas ◽  
Action Plan ◽  
Phase 1 ◽  
Phase 2 ◽  
Strategic Action ◽  
Members Of Parliament ◽  
Professional Nurses

Abstract Background: Accessibility to health care in rural areas of Zimbabwe is challenging. Developing a strategic action plan was in essence, a road map leading to a required potential like achieving a goal. Wider consultation with communities, healthcare leaders and policymakers to inform development of strategic action plan, often overlooked has necessitated this research. The aim was to identify strategies and develop a strategic action plan to enhance accessibility to healthcare in rural areas of Zimbabwe through active involvement of key stakeholders like healthcare users, healthcare workers, leaders and legislators.Methods: A multiple methods approach were used and study was carried out in 4 phases. In Phase 1 (quantitative), data was collected from professional nurses using self-administered questionnaire and health care users using interview questionnaire. Phase 2 (qualitative) collected data through a nominal group with national health directors. A strategic action plan was developed in phase 3 using findings from phase 1 and 2, the Systems Model and a literature control. In phase 4, the strategic action plan was finalised and validated by members of parliamentary portfolio committee on health who were members of parliament of Zimbabwe. Two districts (Masvingo and Chegutu) in two provinces (Masvingo and Mashonaland West) were included in the study, targeting 45 public health facilities in rural areas of Zimbabwe.Participants included in the study were conveniently sampled professional nurses (90), health care users (445) using the sampled public health facilities (phase 1), conveniently sampled 5 national health coordinators (phase 2) and all-inclusive 5 members of the parliamentary portfolio committee on health (phase 4).Results: The study contributed to the development and validation of the strategic action plan with 6 strategies. These included improving the health infrastructure, provision of medical drugs, health workers, medical equipment, reviewing the health worker workload and addressing shortages, and improving the capacity of the health care system.Conclusion: The active participation at all phases by professional nurses, health care users, national health directors and members of parliament contributed to development of a strategic action plan with 6 strategies to enhance accessibility to health care in rural areas of Zimbabwe.

scholarly journals What resources do elderly people choose for managing their symptoms? Clarification of rural older people’s choices of help-seeking behaviors in Japan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ryuichi Ohta ◽  
Mikiya Sato ◽  
Yoshinori Ryu ◽  
Jun Kitayuguchi ◽  
Tetsuhiro Maeno ◽  
...  
Keyword(s):  
Content Analysis ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Help Seeking ◽  
Phase 1 ◽  
Phase 2 ◽  
Retest Reliability ◽  
Professional Care ◽  
Lay Care ◽  
Test Retest Reliability

Abstract Background Appropriate help-seeking behavior (HSB) that involves lay and professional care may moderate the usage of medical resources and promote good health, especially among the rural elderly. However, there is little evidence regarding the rural elderly’s HSB choices for mild symptoms. Therefore, this study attempts to bridge this gap. Methods The participants were patients living in rural areas and over the age of 65, who attended Japanese clinics and general hospitals. In Phase 1, monthly diaries and one-on-one interviews about their mild symptoms and HSB were used to establish HSB items and assess its content validity. Content analysis helped determine the items. In Phase 2, participants were asked to complete the list to measure HSB. The answers to the list and HSB mentioned in the diaries were compared to evaluate concurrent validity. Retests were conducted to examine the content’s reliability and test-retest reliability. Results Phase 1 included 267 participants (average age = 75.1 years, standard deviation [SD] = 4.3; 50.1% male). The diary collection rate was 97.6%. Of the participants, 70.4% used lay care and 25.4% used professional care. Content analysis identified eight types of lay care and four types of professional care. Phase 2 included 315 participants (average age = 77.7 years, SD = 8.27; 46.0% male). In terms of validity, the results of the list and the diaries were correlated (Spearman r 0.704; p < 0.001). The most common behavior with mild symptoms was consulting with primary care physicians, followed by self-care and using home medicine. The test-retest reliability for mild symptoms found kappa values of 0.836 for lay care and 0.808 for professional care. Conclusions The choices of HSB for mild symptoms clarified identified in this study have high validity and reliability. Therefore, it can be used to assess the relationships between HSB and health conditions and the effectiveness of health promotion on rural older people’s HSB.

Rationalization and internalization

2001 ◽  
Vol 60 (4) ◽  
pp. 215-230 ◽  
Author(s):  
Jean-Léon Beauvois
Keyword(s):  
Phase 1 ◽  
Facilitatory Effect ◽  
Phase 2 ◽  
Causal Explanations ◽  
Reduction Effect ◽  
Dissonance Reduction

After having been told they were free to accept or refuse, pupils aged 6–7 and 10–11 (tested individually) were led to agree to taste a soup that looked disgusting (phase 1: initial counter-motivational obligation). Before tasting the soup, they had to state what they thought about it. A week later, they were asked whether they wanted to try out some new needles that had supposedly been invented to make vaccinations less painful. Agreement or refusal to try was noted, along with the size of the needle chosen in case of agreement (phase 2: act generalization). The main findings included (1) a strong dissonance reduction effect in phase 1, especially for the younger children (rationalization), (2) a generalization effect in phase 2 (foot-in-the-door effect), and (3) a facilitatory effect on generalization of internal causal explanations about the initial agreement. The results are discussed in relation to the distinction between rationalization and internalization.

PENERAPAN MODEL QUANTUM LEARNING UNTUK MENINGKATKAN HASIL BELAJAR AUTOCAD SISWA KELAS X TEKNIK PEMESINAN SMK NEGERI 1 STABAT

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Abdul Hasan Saragih
Keyword(s):  
Positive Response ◽  
Phase 1 ◽  
First Grade ◽  
Learning Model ◽  
Second Phase ◽  
Phase 2 ◽  
Phase 3 ◽  
The Third ◽  
Third Phase ◽  
Quantum Learning

This classroom research was conducted on the autocad instructions to the first grade of mechinary class of SMK Negeri 1 Stabat aiming at : (1) improving the student’ archievementon autocad instructional to the student of mechinary architecture class of SMK Negeri 1 Stabat, (2) applying Quantum Learning Model to the students of mechinary class of SMK Negeri 1 Stabat, arising the positive response to autocad subject by applying Quantum Learning Model of the students of mechinary class of SMK Negeri 1 Stabat. The result shows that (1) by applying quantum learning model, the students’ achievement improves significantly. The improvement ofthe achievement of the 34 students is very satisfactory; on the first phase, 27 students passed (70.59%), 10 students failed (29.41%). On the second phase 27 students (79.41%) passed and 7 students (20.59%) failed. On the third phase 30 students (88.24%) passed and 4 students (11.76%) failed. The application of quantum learning model in SMK Negeri 1 Stabat proved satisfying. This was visible from the activeness of the students from phase 1 to 3. The activeness average of the students was 74.31% on phase 1,81.35% on phase 2, and 83.63% on phase 3. (3) The application of the quantum learning model on teaching autocad was very positively welcome by the students of mechinary class of SMK Negeri 1 Stabat. On phase 1 the improvement was 81.53% . It improved to 86.15% on phase 3. Therefore, The improvement ofstudent’ response can be categorized good.

In situ deteriorating patient simulation in general practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711425
Author(s):  
Joanna Lawrence ◽  
Petronelle Eastwick-Field ◽  
Anne Maloney ◽  
Helen Higham
Keyword(s):  
Life Support ◽  
Early Recognition ◽  
Phase 1 ◽  
Patient Simulation ◽  
Medical Emergency ◽  
Phase 2 ◽  
Action Plans ◽  
Integrated Simulation ◽  
Deteriorating Patient

BackgroundGP practices have limited access to medical emergency training and basic life support is often taught out of context as a skills-based event.AimTo develop and evaluate a whole team integrated simulation-based education, to enhance learning, change behaviours and provide safer care.MethodPhase 1: 10 practices piloted a 3-hour programme delivering 40 minutes BLS and AED skills and 2-hour deteriorating patient simulation. Three scenarios where developed: adult chest pain, child anaphylaxis and baby bronchiolitis. An adult simulation patient and relative were used and a child and baby manikin. Two facilitators trained in coaching and debriefing used the 3D debriefing model. Phase 2: 12 new practices undertook identical training derived from Phase 1, with pre- and post-course questionnaires. Teams were scored on: team working, communication, early recognition and systematic approach. The team developed action plans derived from their learning to inform future response. Ten of the 12 practices from Phase 2 received an emergency drill within 6 months of the original session. Three to four members of the whole team integrated training, attended the drill, but were unaware of the nature of the scenario before. Scoring was repeated and action plans were revisited to determine behaviour changes.ResultsEvery emergency drill demonstrated improved scoring in skills and behaviour.ConclusionA combination of: in situ GP simulation, appropriately qualified facilitators in simulation and debriefing, and action plans developed by the whole team suggests safer care for patients experiencing a medical emergency.

Clinical Drug Development for the Treatment of Pulmonary Arterial Hypertension: Collaboration With the Pharmaceutical Industry and Regulatory Agencies

2010 ◽  
Vol 9 (4) ◽  
pp. 214-219
Author(s):  
Robyn J. Barst
Keyword(s):  
Clinical Trials ◽  
Pulmonary Arterial Hypertension ◽  
Drug Development ◽  
Phase 1 ◽  
Preclinical Studies ◽  
Phase 2 ◽  
Phase 3 ◽  
Preclinical Testing ◽  
New Drug ◽  
Pulmonary Arterial

Drug development is the entire process of introducing a new drug to the market. It involves drug discovery, screening, preclinical testing, an Investigational New Drug (IND) application in the US or a Clinical Trial Application (CTA) in the EU, phase 1–3 clinical trials, a New Drug Application (NDA), Food and Drug Administration (FDA) review and approval, and postapproval studies required for continuing safety evaluation. Preclinical testing assesses safety and biologic activity, phase 1 determines safety and dosage, phase 2 evaluates efficacy and side effects, and phase 3 confirms efficacy and monitors adverse effects in a larger number of patients. Postapproval studies provide additional postmarketing data. On average, it takes 15 years from preclinical studies to regulatory approval by the FDA: about 3.5–6.5 years for preclinical, 1–1.5 years for phase 1, 2 years for phase 2, 3–3.5 years for phase 3, and 1.5–2.5 years for filing the NDA and completing the FDA review process. Of approximately 5000 compounds evaluated in preclinical studies, about 5 compounds enter clinical trials, and 1 compound is approved (Tufts Center for the Study of Drug Development, 2011). Most drug development programs include approximately 35–40 phase 1 studies, 15 phase 2 studies, and 3–5 pivotal trials with more than 5000 patients enrolled. Thus, to produce safe and effective drugs in a regulated environment is a highly complex process. Against this backdrop, what is the best way to develop drugs for pulmonary arterial hypertension (PAH), an orphan disease often rapidly fatal within several years of diagnosis and in which spontaneous regression does not occur?

scholarly journals A phase 1 and randomized controlled phase 2 trial of the safety and efficacy of the combination of gemcitabine and docetaxel with ontuxizumab (MORAb‐004) in metastatic soft‐tissue sarcomas

Cancer ◽  
2019 ◽  
Vol 125 (14) ◽  
pp. 2445-2454 ◽  
Author(s):  
Robin L. Jones ◽  
Sant P. Chawla ◽  
Steven Attia ◽  
Patrick Schöffski ◽  
Hans Gelderblom ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Phase 1 ◽  
Soft Tissue Sarcomas ◽  
Phase 2 ◽  
Safety And Efficacy ◽  
Randomized Controlled ◽  
Phase 2 Trial

scholarly journals Quantitative Checklist for Autism in Toddlers (Q-CHAT). A population screening study with follow-up: the case for multiple time-point screening for autism

2021 ◽  
Vol 5 (1) ◽  
pp. e000700
Author(s):  
Carrie Allison ◽  
Fiona E Matthews ◽  
Liliana Ruta ◽  
Greg Pasco ◽  
Renee Soufer ◽  
...  
Keyword(s):  
Phase 1 ◽  
Autism Spectrum ◽  
Population Screening ◽  
Diagnostic Assessment ◽  
Test Accuracy ◽  
Multiple Time ◽  
Phase 2 ◽  
Time Points ◽  
Screening Study

ObjectiveThis is a prospective population screening study for autism in toddlers aged 18–30 months old using the Quantitative Checklist for Autism in Toddlers (Q-CHAT), with follow-up at age 4.DesignObservational study.SettingLuton, Bedfordshire and Cambridgeshire in the UK.Participants13 070 toddlers registered on the Child Health Surveillance Database between March 2008 and April 2009, with follow-up at age 4; 3770 (29%) were screened for autism at 18–30 months using the Q-CHAT and the Childhood Autism Spectrum Test (CAST) at follow-up at age 4.InterventionsA stratified sample across the Q-CHAT score distribution was invited for diagnostic assessment (phase 1). The 4-year follow-up included the CAST and the Checklist for Referral (CFR). All with CAST ≥15, phase 1 diagnostic assessment or with developmental concerns on the CFR were invited for diagnostic assessment (phase 2). Standardised diagnostic assessment at both time-points was conducted to establish the test accuracy of the Q-CHAT.Main outcome measuresConsensus diagnostic outcome at phase 1 and phase 2.ResultsAt phase 1, 3770 Q-CHATs were returned (29% response) and 121 undertook diagnostic assessment, of whom 11 met the criteria for autism. All 11 screened positive on the Q-CHAT. The positive predictive value (PPV) at a cut-point of 39 was 17% (95% CI 8% to 31%). At phase 2, 2005 of 3472 CASTs and CFRs were returned (58% response). 159 underwent diagnostic assessment, including 82 assessed in phase 1. All children meeting the criteria for autism identified via the Q-CHAT at phase 1 also met the criteria at phase 2. The PPV was 28% (95% CI 15% to 46%) after phase 1 and phase 2.ConclusionsThe Q-CHAT can be used at 18–30 months to identify autism and enable accelerated referral for diagnostic assessment. The low PPV suggests that for every true positive there would, however, be ~4–5 false positives. At follow-up, new cases were identified, illustrating the need for continued surveillance and rescreening at multiple time-points using developmentally sensitive instruments. Not all children who later receive a diagnosis of autism are detectable during the toddler period.

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